Imperforate hymen causing bilateral hydroureteronephrosis in an infant with bicornuate uterus

Abstract

A rare case of imperforate hymen associated with bicornuate uterus in an infant is presented as a cause of bilateral hydroureteronephrosis and pelvic mass in infancy. The importance of postoperative radiologic evaluation for diagnosis of accompanying uterine abnormalities is introduced. A 8-month-old girl with restlessness and intermittent fever was brought to the daily outpatient clinic by her parents. Ultrasound exam showed bilateral grade 4 hydroureteronephrosis and a large cystic pelvic mass. Magnetic resonance scan of the pelvis revealed marked hematocolpos. A cruciate incision was made over the hymen under general anesthesia. During a 6-month followup gradual resolution of bilateral hydroureteronephrosis was documented. Although the details of the uterine anomaly were obscured in preoperative imaging, postoperative US and MR demonstrated bicornuate uterus. Postoperative pelvic radiologic examination is highly recommended to verify the resolution of hematocolpos and to screen for any concomitant anomalies that can have long-term clinical significance.

Figure 1

Pelvic US. (a) Transverse view shows a large well-defined cystic mass with internal echoes, which could easily be misinterpreted as overly distended urinary bladder. Note the bilateral ureteral dilatation. (b) Insertion of a Foley catheter makes it clear that the cystic mass is separate from the urinary bladder which is severely compressed and therefore hard to detect on ultrasound.

Figure 2

Sagittal-T2-weighted MR image. Marked distention of the uterus and cervix is demonstrated. Note the compressed urinary bladder with little urine in it.

Figure 3

Preoperative VCUG. Image reveals no reflux but a urinary bladder which could not receive appropriate amount of contrast material due to severe compression secondary to hematocolpos.

Figure 4

T1-weighed postoperative MR images. (a) and (b): two consecutive pelvic coronal images clearly show the two cavities (arrows) of the uterus separated by an incomplete longitudinal septum which was difficult to depict earlier. (c) axial view through corpus shows bicornuate uterus.